Clinical effect of totally laparoscopic radical resection for gallbladder cancer

Abstract

Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer. Methods The retrospective cross-sectional descriptive study was adopted. The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected. The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients, and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection. The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination. Observation indicators included (1) operation situations, including surgical procedures, operation time, volume of intraoperative blood loss and number of lymph node dissected, (2) postoperative situations, including time for out-off-bed activity, time for diet intake, time of drainage tube removal, occurrence of complications and duration of hospital stay, (3) results of postoperative pathological examination, including tumor stage and surgical margin, (4) postoperative adjuvant treatment, (5) follow-up situation including the survival of patients, tumor recurrence and metastasis. The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015. Count data were represented as average (range). Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection+ lymph node dissection at N1 region. Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection+ Roux-en-Y hepaticojejunostomy, without perioperative death.The average operation time, average volume of intraoperative blood loss and average number of intraoperative lymph node dissected were 238 minutes (range, 178-430 minutes), 250 mL (range, 200-600 mL) and 7 (range, 4-15), respectively. (2) The patients got out-off-bed activity and normal diet intake at postoperative day 2, with a average time of drainage tube removal of 3 days (range, 0-25 days) and an average duration of hospital stay of 5 days (range, 3-28 days). Two patients with complications were cured by symptomatic treatment. (3) Results of postoperative pathological examination showed that all the patients received R0 resection, and pathological stage showed that 12 patients were detected inⅠB stage, 10 inⅡstage, 7 in ⅢA stage and 1 in ⅢB stage. (4) One patient in ⅢB stage (pT3N1M0 stage ) received gemcitabine+ cisplatin chemotherapy and other patients didn't receive the adjuvant treatment. (5) All the patients were followed up for a median time of 16 months (range, 4-32 months), without tumor recurrence and metastasis at Trocar puncture site. There were 25 patients with tumor-free survival and 5 patiens died of tumor recurrence. Conclusion Laparoscopic radical resection of gallbladder cancer is technically safe and feasible, with a satisfactory short-term outcome. Key words: Gallbladder neoplasms; Radical resection; Laparoscopy